Neuroimaging and genetic associations of attentional and hypnotic processes

Neural functional correlates of hypnosis and hypnoanalgesia: Role of the cingulate cortex

Hypnosis is a hetero-induced or self-induced altered state of consciousness that involves focused attention and reduced peripheral awareness. It is determined by response to suggestions and can be used in the management of various clinical conditions. Nowadays there is growing attention to the neurobiological correlates of hypnosis because of its future clinical applications. The greater attention is due to the wide range of applications that might stem from its knowledge. Functional neuroimaging studies show that hypnosis affects attention by modulating the activation of the anterior cingulate cortex and other brain areas, modifying the conflict monitoring and cognitive control. During hypnoanalgesia, several changes in brain functions occur in all the areas of the pain network, and other brain areas. Among these, the anterior cingulate cortex is significantly involved in modulating the activity of pain circuits under hypnosis, both in the affective, sensory-cognitive, and behavioral aspects. The study of the functionality of the cingulate cortices, mainly the anterior and medial portions, appears to be crucial for better understanding the hypnotic phenomena, related to both the neurocognitive and somatosensory aspects.

Ictal SPECT in Psychogenic Nonepileptic and Epileptic Seizures

BACKGROUND

Psychogenic nonepileptic seizures (PNES) are a common and debilitating problem in patients with epilepsy. They can be virtually indistinguishable from epileptic seizures, demanding video-electroencaphalogram monitoring, which is costly and not widely available, for differential diagnosis. Specific functional brain correlates of PNES have not been demonstrated so far. We hypothesized that PNES and epileptic seizures have distinct brain activation patterns, assessed by functional neuroimaging during ictal events of both conditions.

OBJECTIVE

Compare ictal brain activation patterns of PNES and epileptic seizures using single-photon emission computerized tomography.

METHODS

We prospectively assessed brain functional activation using single-photon emission computerized tomography 99mTc-ethyl cysteinate dimer in 26 patients with PNES, confirmed by trained psychiatrists in epileptology, who had their seizures induced by provocative tests compared with 22 age- and sex-matched subjects with temporal lobe epilepsy who underwent prolonged intensive video-electroencaphalogram monitoring.

RESULTS

In PNES patients compared with temporal lobe epilepsy group, we found a consistent increase in regional cerebral blood flow in the right precuneus (Brodmann area 7; P = 0.003) and right posterior cingulate cortex (Brodmann area 31; P = 0.001), as well as a decrease in regional cerebral blood flow in the right amygdala (P = 0.027).

CONCLUSIONS

Activation of default mode network brain areas and temporoparietal junction may be a distinct feature of ictal PNES and could be explained by a disruption between movement prediction input and sensory outcome. Such information mismatch might be the neurobiological underpinning of dissociative episodes.

A Pragmatic Guide to the Setting up of Integrated Hypnotherapy Services in Primary Care and Clinical Settings

Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.

Intentional action processing results from automatic bottom-up attention: An EEG-investigation into the Social Relevance Hypothesis using hypnosis

Social stimuli grab our attention. However, it has rarely been investigated how variations in attention affect the processing of social stimuli, although the answer could help us uncover details of social cognition processes such as action understanding. In the present study, we examined how changes to bottom-up attention affects neural EEG-responses associated with intentional action processing. We induced an increase in bottom-up attention by using hypnosis. We recorded the electroencephalographic μ-wave suppression of hypnotized participants when presented with intentional actions in first and third person perspective in a video-clip paradigm. Previous studies have shown that the μ-rhythm is selectively suppressed both when executing and observing goal-directed motor actions; hence it can be used as a neural signal for intentional action processing. Our results show that neutral hypnotic trance increases μ-suppression in highly suggestible participants when they observe intentional actions. This suggests that social action processing is enhanced when bottom-up attentional processes are predominant. Our findings support the Social Relevance Hypothesis, according to which social action processing is a bottom-up driven attentional process, and can thus be altered as a function of bottom-up processing devoted to a social stimulus.

Hypnosis-based psychodynamic treatment in ALS: a longitudinal study on patients and their caregivers

Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects.

Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients' primary caregivers and 15 one-by-one matched control patients were considered in the study. Measurements of anxiety, depression and quality of life (QoL) were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients' anxiety, depression, QoL, and functional impairment (ALSFRS-r), as well as on caregivers' anxiety and depression.

Results: The statistical analyses revealed an improvement in psychological variables' scores immediately after the treatment. Amelioration in patients' and caregivers' anxiety as well as caregivers' depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group's patients.

Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS.

Hypnotizability and Catechol-O-Methyltransferase (COMT) polymorphysms in Italians

Higher brain dopamine content depending on lower activity of Catechol-O-Methyltransferase (COMT) in subjects with high hypnotizability scores (highs) has been considered responsible for their attentional characteristics. However, the results of the previous genetic studies on association between hypnotizability and the COMT single nucleotide polymorphism (SNP) rs4680 (Val¹⁵⁸Met) were inconsistent. Here, we used a selective genotyping approach to re-evaluate the association between hypnotizability and COMT in the context of a two-SNP haplotype analysis, considering not only the Val¹⁵⁸Met polymorphism, but also the closely located rs4818 SNP. An Italian sample of 53 highs, 49 low hypnotizable subjects (lows), and 57 controls, were genotyped for a segment of 805 bp of the COMT gene, including Val¹⁵⁸Met and the closely located rs4818 SNP. Our selective genotyping approach had 97.1% power to detect the previously reported strongest association at the significance level of 5%. We found no evidence of association at the SNP, haplotype, and diplotype levels. Thus, our results challenge the dopamine-based theory of hypnosis and indirectly support recent neuropsychological and neurophysiological findings reporting the lack of any association between hypnotizability and focused attention abilities.

Oxytocin and cortisol in the hypnotic interaction

Changes in oxytocin and cortisol levels were tested in healthy volunteers during hypnotic interactions in standardized laboratory sessions. Pre- to posthypnosis changes of oxytocin and cortisol were related to the hypnotic susceptibility of subjects and the relational experiences reposted by subjects and hypnotists on several paper-and-pencil tests. Results show that the changes in oxytocin are not related to hypnotic susceptibility but to relational experiences. After the hypnotic interaction, the subject's oxytocin level increased if perceived harmony with the hypnotist was high, whereas it increased in the hypnotist if the subject had memories of less warm emotional relationships with his or her parents. The results are interpreted within the social-psychobiological model of hypnosis.

Hypnotizability, hypnosis and prepulse inhibition of the startle reflex in healthy women: an ERP analysis

A working model of the neurophysiology of hypnosis suggests that highly hypnotizable individuals (HHs) have more effective frontal attentional systems implementing control, monitoring performance, and inhibiting unwanted stimuli from conscious awareness, than low hypnotizable individuals (LHs). Recent studies, using prepulse inhibition (PPI) of the auditory startle reflex (ASR), suggest that HHs, in the waking condition, may show reduced sensory gating although they may selectively attend and disattend different stimuli. Using a within subject design and a strict subject selection procedure, in waking and hypnosis conditions we tested whether HHs compared to LHs showed a significantly lower inhibition of the ASR and startle-related brain activity in both time and intracerebral source localization domains. HHs, as compared to LH participants, exhibited (a) longer latency of the eyeblink startle reflex, (b) reduced N100 responses to startle stimuli, and (c) higher PPI of eyeblink startle and of the P200 and P300 waves. Hypnosis yielded smaller N100 waves to startle stimuli and greater PPI of this component than in the waking condition. sLORETA analysis revealed that, for the N100 (107 msec) elicited during startle trials, HHs had a smaller activation in the left parietal lobe (BA2/40) than LHs. Auditory pulses of pulse-with prepulse trials in HHs yielded less activity of the P300 (280 msec) wave than LHs, in the cingulate and posterior cingulate gyrus (BA23/31). The present results, on the whole, are in the opposite direction to PPI findings on hypnotizability previously reported in the literature. These results provide support to the neuropsychophysiological model that HHs have more effective sensory integration and gating (or filtering) of irrelevant stimuli than LHs.

The association between the oxytocin receptor gene (OXTR) and hypnotizability

Hypnosis has puzzled scientists for centuries, and particularly the reason why some people are prone to engaging in suggested experiences discordant with external reality. Absorption in internal experience is one key component of the hypnotic response. The neuropeptide oxytocin has been posited to heighten sensitivity to external cues, and it is possible that individual differences in oxytocin-related capacity to engage in external or internal experiences influences hypnotic response. To test this proposal, 185 Caucasian individuals provided saliva samples for analysis of polymorphisms in the oxytocin receptor gene, COMT, and independently completed standardized measures of hypnotizability and absorption. Participants with the GG genotype at rs53576 were characterized by lower hypnotizability and absorption scores than those with the A allele; there was no association between hyponotizability and COMT. These findings provide initial evidence that the capacity to respond to suggestions for altered internal experience is influenced by the oxytocin receptor gene, and is consistent with evidence that oxytocin plays an important role in modulating the extent to which people engage with external versus internal experiences.

Phenomenological aspects of hypnotic interactions: the effect of kinship

This study analyzes the relationship of various measures of hypnosis as a function of kinship. Subjects with varying degrees of kinship (mono- and dizygotic twins, siblings, and parent-child pairs) participated. The Stanford Hypnotic Susceptibility Scale, Form A (SHSS:A), as well as other measures-including the Dyadic Interactional Harmony (DIH) and the Phenomenology of Consciousness Inventory (PCI)-were used with both subjects and hypnosis practitioners. Findings indicated that the phenomenological experience of hypnosis is not determined genetically. The subjects apparently evaluated the session as related to the degree of kinship. MZ twins-on the basis of reactive interactional pattern-evaluate the hypnotic interaction similarly. This was not true for SHSS:A scores or the phenomenological aspects of the state (PCI). These findings were interpreted within the sociopsychobiological model of hypnosis.

The facilitating effect of clinical hypnosis on motor imagery: an fMRI study

Hypnosis is increasingly being employed in therapy of neurologically impaired patients. In fact, reports from neuropsychological practice point out that neurological patients with a loss of motor abilities achieve successful rehabilitation by means of motor imagery during hypnosis. This approach was shown to be effective even if the patients' ability to imagine movements was impaired or lost. The underlying mechanisms of "how" and "where" hypnosis affects the brain, however, are largely unknown. To identify the brain areas involved in motor imagery under hypnosis, we conducted an fMRI study in which we required healthy human subjects either to imagine or to execute repetitive finger movements during a hypnotic trance. We observed fMRI-signal increases exclusively related to hypnosis in the left superior frontal cortex, the left anterior cingulate gyrus and left thalamus. While the superior frontal cortex and the anterior cingulate were active related more to movement performance than to imagery, the thalamus was activated only during motor imagery. These areas represent central nodes of the salience network linking primary and higher motor areas. Therefore, our data substantiate the notion that hypnosis enhances motor imagery.

Neurocognition under hypnosis: findings from recent functional neuroimaging studies

Functional neuroimaging studies show that hypnosis affects attention by modulating anterior cingulate cortex activation and uncoupling conflict monitoring and cognitive control function. Considering functional changes in the activation of the occipital and temporal cortices, precuneus, and other extrastriate visual areas, which account for hypnosis-induced altered reality perception, the role of mental imagery areas appears to be central under hypnosis. This is further stressed by the fact that motor commands are processed differently in the normal conscious state, deviating toward the precuneus and extrastriate visual areas. Functional neuroimaging also shows that posthypnotic suggestions alter cognitive processes. Further research should investigate the effects of hypnosis on other executive functions and personality measures.

Inferior frontal white matter asymmetry correlates with executive control of attention

White matter (WM) asymmetries of the human brain have been well documented using diffusion tensor imaging (DTI). However, the relationship between WM asymmetry pattern and cognitive performance is poorly understood. By means of tract-based spatial statistics (TBSS) and voxel-based analyses of whole brain, this study examined the WM asymmetries and the correlations between WM integrity/asymmetries and three distinct components of attention, namely alerting, orienting, and executive control (EC), which were assessed by attention network test (ANT). We revealed a number of WM anisotropy asymmetries, including leftward asymmetry of cingulum, corticospinal tract and cerebral peduncle, rightward asymmetry of internal capsule, superior longitudinal fasciculus and posterior corona radiata, as well as heterogeneous asymmetries in anterior corpus callosum and anterior corona radiata (ACR). Moreover, specific correlation was found between asymmetric pattern of inferior frontal ACR and EC performance. Additionally, this study also proposed that there were no significant relationships of WM anisotropy asymmetries to alerting and orienting functions. Further clusters of interest analyses and probabilistic fiber tracking validated our findings. In conclusion, there are a number of differences in WM integrity between human brain hemispheres. Specially, the anisotropy asymmetry in inferior frontal ACR plays a crucial role in EC function. Our finding is supportive of the functional studies of inferior frontal regions and in keeping with the theory of the brain lateralization on human ventral attention system.

Association between hypnotizability and the catechol-O-methyltransferase (COMT) polymorphism

Previous studies implicate involvement of dopaminergic systems in hypnotizability and report association with the COMT Val(158)Met single nucleotide polymorphism (SNP, rs4680) demonstrating the Val/Met heterozygotes as the most hypnotizable group using the Stanford Hypnotic Susceptibility Scale. This study replicates that association using an independent sample of 127 healthy Hungarian young adults and the Waterloo-Stanford Group C Scale of Hypnotic Susceptibility. Significant association (p = .016) was found between the COMT genotypes and hypnotizability, with a clear additive effect of the Val allele: Hypnotizability scores were highest in Val/Val (5.9), intermediate in Val/Met (4.7), and lowest in Met/Met (4.1). Differences between these results and those of previous studies support recent findings suggesting an inverted-U-shaped relation between dopamine level in the prefrontal cortex and cognitive functioning. The present study replicates association of COMT Val(158)Met SNP and hypnotizability and stresses the importance of mediating factors, such as group vs. individual inductions.

Attention control and susceptibility to hypnosis

The present work aimed at assessing whether the interference exerted by task-irrelevant spatial information is comparable in high- and low-susceptible individuals and whether it may be eliminated by means of a specific posthypnotic suggestion. To this purpose high- and low-susceptible participants were tested using a Simon-like interference task after the administration of a suggestion aimed at preventing the processing of the irrelevant spatial information conveyed by the stimuli. The suggestion could be administered either in the absence or following a standard hypnotic induction. We showed that, outside from the hypnotic context, the Simon effect was similar in high and low-susceptible participants and it was significantly reduced following the posthypnotic suggestion in high-susceptible participants only. These results show that a specific posthypnotic suggestion can alter information processing in high-susceptible individuals and reduce the interfering effect exerted by arrow stimuli.

Mind-Body Medicine and Immune System Outcomes: A Systematic Review

This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Relaxation Training (n=25), Cognitive Based Stress Management (n=22), and Hypnosis (n=21). Half the studies were conducted with healthy subjects (n=51). HIV (n=18), cancer (n=13) and allergies (n=7) were the most prominent conditions examined in the studies comprising of non-healthy subjects. Natural killer cell and CD4 T lymphocyte measures were the most commonly studied outcomes. Most outcome and modality categories had limited or inconclusive evidence. Relaxation training had the strongest scientific evidence of a mind-body medicine affecting immune outcomes. Immunoglobulin A had the strongest scientific evidence for positive effects from mind-body medicine. Issues for mind-body medicine studies with immune outcomes are discussed and recommendations are made to help improve future clinical trials.

A structural equation model of depression and the defense system factors: a survey among Chinese college students

Questionnaires were administered to a large sample of subjects (1363 Chinese college students), to evaluate the mediating risk factors in the defense system of depression, including personality, coping skills, interpersonal context and family environment. Structural equation modeling (SEM) was used to analyze a total of 12 variables in order to understand how they interact with each other. Eysenck's Neuroticism, Extraversion, and Psychoticism personality types act as the essential parts of the model, both directly and indirectly impacting depression. Coping styles are the mediators that regulate the effects of personality and family environment on depression. Family environment has only indirect effects through personality and positive coping style. Interpersonal context may not have had a significant correlation with depression, but was influenced by family environment and had a correlation with positive coping style. According to the results, therapies based on personality adjustment, family environment and coping styles of college students are greatly recommended among college students in order to lessen the chances of or to prevent depression. The present results may advance our understanding of depression etiology in young Chinese adults and provide suggestions of factors that should be taken into account in the evaluation, treatment and even the prevention of depression.

Mind-body interventions: applications in neurology

OBJECTIVE

Half of the adults in the United States use complementary and alternative medicine with mind-body therapy being the most commonly used form. Neurology patients often turn to their physicians for insight into the effectiveness of the therapies and resources to integrate them into their care. The objective of this article is to give a clinical overview of mind-body interventions and their applications in neurology.

METHODS

Medline and PsychInfo were searched on mind-body therapies and neurologic disease search terms for clinical trials and reviews and published evidence was graded.

RESULTS

Meditation, relaxation, and breathing techniques, yoga, tai chi, and qigong, hypnosis, and biofeedback are described. Mind-body therapy application to general pain, back and neck pain, carpal tunnel syndrome, headaches, fibromyalgia, multiple sclerosis, epilepsy, muscular dysfunction, stroke, aging, Parkinson disease, stroke, and attention deficit-hyperactivity disorder are reviewed.

CONCLUSIONS

There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.

Neurobiological factors linking personality traits and major depression

OBJECTIVE

To examine the neurobiological basis of personality and depression.

METHOD

We examined preclinical and clinical studies related to neuroanatomy, neuroendocrine, molecular, and genetic alterations in depressed patients. We considered whether common neurobiological factors might be shared between personality and depression.

RESULTS

Preclinical studies provide insights into the neurobiological mechanisms underlying the pathophysiology of depression including neuroendocrine alterations in hypothalamic-pituitary-adrenal (HPA) function, neuroanatomical alterations in key brain regions, and alterations in neurotrophin and serotonergic signalling systems. Clinical studies show similar alterations in depressed patients. Evidence suggests that neuroendocrine alterations in HPA function may contribute to personality traits. Brain regions implicated in depression, including the hippocampus and the anterior cingulate cortex, might play a role in personality. Key molecules implicated in depression have been extensively studied with reference to personality traits, particularly neuroticism. To date, physiological measures (serum and positron emission tomography) provide the strongest evidence implicating brain-derived neurotrophic factor and serotonin in personality, while genetic evidence is less convincing.

CONCLUSIONS

A neurobiological link exists between personality and depression; however, more work is needed to provide an understanding of the nature of this relation and to link this work with clinical studies examining the influence of personality factors on depression.

Genetics and neuroimaging of attention and hypnotizability may elucidate placebo

Attention binds psychology to the techniques of neuroscience and exemplifies the links between brain and behavior. Associated with attentional networks, at least 3 brain modules govern control processes by drawing on disparate functional neuroanatomy, neuromodulators, and psychological substrates. Guided by data-driven brain theories, researchers have related specific genetic polymorphisms to well-defined phenotypes, including those associated with different attentional efficiencies and hypnosis. Because attention can modulate both cognitive and affective processes, genetic assays together with neuroimaging data have begun to elucidate individual differences. Findings from genetic assays of both attention and hypnotizability pave the way to answering questions such as how high hypnotizable individuals may differ from less-hypnotizable persons. These exploratory findings may extend to the identification of placebo responders.

Suggestibility and hypnotizability: mind the gap

Suggestion, both within and outside of hypnosis, can influence many psychological processes, including cognition and emotion. Moreover, suggestion may account for many individual differences and promote the investigation of such mainstream fields as attention and memory. To be sure, exploring the power of suggestion will likely pave the road to a more scientific understanding of such psychological phenomena as motivation, expectation, and the placebo effect.